"Bridalplasty": Plastic Surgery as a TV Prize?

One part "Bridezillas," another part "Extreme Makeover," E!'s new reality T.V. Series "Bridalplasty" pits brides-to-be against each other in a competition for nose jobs, implants, lipo and the ultimate prize: a celebrity-worthy dream wedding.

"Every bride wants to look her best on her wedding day but for the women competing on E!'s new series, 'Bridalplasty,' only perfection will do," says the network in a statement about the show. "'Bridalplasty' brings together engaged women who are seeking complete image transformations before their big day -- they want the dream wedding AND the dream body to go along with it."

"Bridalplasty" will be the first American reality show to have participants compete for plastic surgery. There have been shows about people having plastic surgery, but in "Bridalplasty," it's the prize -- pushing the limits of medical ethics.

Under the American Society of Plastic Surgeons code of ethics, "We're technically prohibited from giving procedures away as a prize for a contest. It totally undermines the doctor-patient relationship," says Dr. Gayle Gordillo, associate professor plastic surgery at Ohio State University. "The ethical and social implications of this [show] are frightening."

Competing in wedding-themed challenges such as writing vows and planning honeymoons, "each week one lucky bride will ? get one piece of her dream body -- going under the knife for one of the surgeries off her 'wish list,'' performed by celebrity plastic surgeon Dr. Terry Dubrow, the network writes. Dubrow is not new to reality TV: he was also the lead surgeon on Fox's show, "The Swan," in 2004.

The last bride standing will win the remaining procedures on her list and the dream wedding she has planned along the way, not revealing her new face and physique to her husband-to-be until they're at the altar. The ten-part show premieres Nov. 28.

While plastic surgeons agree that it is not uncommon for women to come in for a procedure or two in preparation for their big day, doctors and psychologists worry that the circumstances under which "Bridalplasty" provides these makeovers raise troubling social, ethical, and medical issues.

"It's a horrible idea. It absolutely plays into this notion that if you achieve the 'perfect' appearance, everything will be better. The message it sends to girls and women, as if you're not beautiful enough on your wedding day you have to receive plastic surgery from head to toe," says Roberto Olivardia, clinical instructor in the department of psychology at Harvard Medical School.

In Sickness and in Recovery -- Will Their Grooms Have Them?

"This plays into the fact that women want to look their best on that day ? it is part of a societal sickness about needing to achieve perfection, as if cosmetic surgery achieves that," says Olivardia.

The fact that this need for surgical perfection occurs within the framework of marriage is even more troubling, he says. "This person is choosing to marry you because they love you already. These people are going to undergo these drastic plastic surgeries, who's to say that the groom will think of them in the same way afterwards?"

"It would raise questions in my mind about the strength of a marriage built on one individual making a decision in which the other had no role. A 'life partner' should be there to assist and support the individual throughout the transformative process," says Dr. Otto Placik, a Chicago-based plastic surgeon.

But Dr. Barry Weintraub, a plastic surgeon and spokesperson for the American Society of Plastic Surgeons, says that one or multiple procedures before going to the altar, even unbeknownst to the groom, are not so unusual.

"This is not new stuff. Brides for decades have had things done before their wedding and they often get people who get touch up things like lifers, Botox. Multiple procedures have been done at the same time for decades and there's nothing wrong with that either," he says. "It only goes too far when it resembles body dysmorphic disorder, when women have unrealistic expectations or are doing it for someone else and not for themselves."

Body dysmorphic disorder, or BDD, is a psychiatric condition in which patients are preoccupied with perceived flaws that can never be fixed. The desire for multiple and continuous cosmetic surgeries is a major warning sign for BDD, especially if the patient is never satisfied after the procedure, Olivardia says.

"I would wonder whether these contestants have BDD. I think you should be looking closely at these women's self esteem before you operate, and I would question surgeons who perform these types of surgeries for people who clearly have an agenda as to what they want to look like," he says.

Weintraub: "It's a real psychological problem and it's up to use as professionals to pick that out and go out of our way not to operate on them."

A Break in a Surgeon's Code of Ethics?

From a medical and ethical standpoint, many plastic surgeons objected to the use of plastic surgery as a prize to be fought over in the new show.

"It's a bad idea on two counts. One, they're rushing a surgery which is dangerous, and more importantly it's totally unethical to offer plastic surgery as the result of winning a contest," says Dr. Garry Brody, professor emeritus of plastic surgery at the University of Southern California.

Technically, "Bridalplasty" may skirt the American Society for Plastic Surgeons' code of ethics, says the society's president-elect, Dr. Michael McGuire. While Dubrow will offer surgery to the show's winner each week, he will have previously evaluated the contestant and pre-approved all the procedures on her "wish list" -- enough to satisfy the code's requirements.

While McGuire calls the show embarrassing to the field and says the society frowns upon taking a "well-recognized specialty down into this level of entertainment," he says that without an actual violation of the code, there is "nothing we can do about it."